Provider Demographics
NPI:1225438070
Name:SUNSET SMILE DENTAL CORP
Entity Type:Organization
Organization Name:SUNSET SMILE DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GINZBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-424-3690
Mailing Address - Street 1:8606 A WEST SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069
Mailing Address - Country:US
Mailing Address - Phone:310-424-3690
Mailing Address - Fax:310-424-3495
Practice Address - Street 1:8606A W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2302
Practice Address - Country:US
Practice Address - Phone:310-424-3690
Practice Address - Fax:310-424-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41789302R00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization